MANAGEMENT OF DIABETES MELLITUS FROM A PUBLIC HEALTH PERSPECTIVE

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SCOPE AND IMPACT OF DIABETES IN THE UNITED STATES

During the past decade, diabetes mellitus has emerged as an important clinical and public health problem throughout the world. In the United States, 8 million adults have been diagnosed with diabetes, 90% to 95% of whom have non–insulin-dependent diabetes mellitus (NIDDM). The prevalence of known cases of diabetes is 6% to 7% for persons aged 45 to 64 years and 10% to 12% for those aged 65 years and older. Even higher rates are found in US minority populations, groups who are at increased risk

MEDICAL CARE FOR PATIENTS WITH DIABETES

Substantial attention has been focused on the organizational and economic aspects of medical care for patients with diabetes.1, 20, 74 Publication of the results of the DCCT14, 15 has heightened interest in the metabolic control of diabetes and its implications for health care policy.2, 19, 55

Several studies have been conducted on representative samples of adults with diabetes in the United States. These studies indicate that health care for diabetes involves primary care practitioners for the

APPROACHING DIABETES FROM A PUBLIC HEALTH PERSPECTIVE

As documented in the previous sections, diabetes is a highly prevalent chronic disease, the long-term complications of which are associated with significantly increased morbidity and mortality. Rates of diabetes are high in the US population, particularly in US minority populations, and seem to be increasing. Diabetes places a major financial burden on the US health care system; 10% to 15% of all health care costs and 25% of Medicare costs are diabetes-related. Diabetes is a public health

IMPLEMENTING A PUBLIC HEALTH APPROACH TO DIABETES CARE

Implementation of a public health approach to diabetes care will require a view toward long-term planning, targeting of patients for improved care, and goal setting for outcomes of care. Patients must be educated and empowered to participate as partners in the care and management of diabetes. This makes patients active participants rather than casual observers in a disease process affected on a daily basis by decisions made by patients. Effective screening evaluations and management

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    Address reprint requests to Sheila H. Roman, MD, MPH, Division of Endocrinology and Metabolism, Mount Sinai Medical Center, Box 1055, One Gustave L. Levy Place, New York, NY 10029–6574

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